tbuckley/cabot-search huggingface dataset:
PB2120: HIV AND MALIGNANT HEMOPATHIES
Authors: H. Khibri, M. Maamar, M. El Amani, N. Jait, M. Bouaouad, S. Haidouri, N. Benlachgar, N. Mouatassim, W. Ammouri, H. Harmouche, M. Adnaoui, Z. Tazi Mezalek
Journal: HemaSphere (2022)

Background: Hematological malignancies remain a major cause of morbidity and mortality in patients living with the HIV virus (PLHIV). Their training would be linked to several factors. Aims: The objective of our study is to describe the main types of blood diseases malignancies and their epidemiological characteristics in PLHIV followed up internal medicine department – ​​clinical hematology of the CHU Ibn Sina in Rabat. Methods: This is a retrospective and descriptive observational study of PLHIV having an associated hematological malignancy. Results: Among the 1035 PLHIV followed, we collected 11 patients with blood disease malignant (1.06%). The average age was 40.6 years (29 – 73 years). The F/M sex ratio was 0.1. 90% of patients were in stage C. Heterosexual transmission was the main mode of contamination (100%). They had as antecedent: chronic smoking 60%; pulmonary tuberculosis 30%; drug addiction 10%. The regimens of ARVs received corresponded to international recommendations: 90% received triple therapy of the TNF+FTC+EFZ type and 10% received DTG+TNF+3TC. HIV infection was discovered incidentally in 73% of PLHIV during the pre-therapeutic assessment of the management of hemopathy. their viral status revealed an average viral load of 6.2 log (4.3 – 6.5 log). the mean CD4 count was estimated at 148 (78 – 243 cells/mm3). 27% of patients had an average follow-up time of 4 months. they had an undetectable viral load and persistently low CD4 count (< 200 /mm3). We identified 9 cases (82%) of NHL: 2 DLBCL (22%), 2 plasmablastic lymphomas (22%), 3 Burkitt’s lymphomas (34%), 1 T-cell lymphoma angioimmunoblastic (11%), 1 T/NK lymphoma (11%), 1 case of classic HL at mixed cellularity (9%), and 1 case of multiple myeloma (9%). The other syndromes lymphoproliferative or myeloproliferative were not found in our series. The advanced Ann Arbor stage (III – IV) was found in 90% of PLHIV. All patients received first-line poly-chemotherapy: 40% of patients received an R-DAEPOCH, 20% CHOEP, 20% R-CHOP, 10% BEACOPP, 10% CTD. 10% of patients required a second line of therapy (R-DHAOX) then a third line (Ciclosporine). The evolution was favorable with remission complete in 30% of patients. A negative viral load was obtained in 80% of PLHIV. We mourn 6 deaths: 5 deaths were related to hematological malignancy, and 1 was related to opportunistic infections complicating HIV after poor adherence to ARVs. Summary/Conclusion: Our series is mainly distinguished by a low frequency of the HIV association – hematological malignancy, but also by the diversity of these hemopathies. The persistence of a low CD4 count in PLHIV on ARVs should encourage look for possible hematological malignancies. Early introduction of ARVs is mandatory before starting any chemotherapy. The prognosis mainly depends type and stage of hemopathies.
PB2280: COVID-19 INFECTION IN PATIENTS WITH ACUTE LEUKEMIA
Authors: M. Shapetska, I. Iskrov, I. Stoma
Journal: HemaSphere (2022)

Background: Due to disorders in the immune system associated with the manifestations of the oncohematological disease and specific therapy, against the background of the development of secondary immunodeficiency syndrome, patients with acute leukemia are at high risk of infection during the COVID-19 pandemic. Patients with hematological malignancies tend to have higher rates of COVID-19 complications and higher mortality (30% to 62%) compared to patients in the general population. Aims: Evaluate overall survival in patients with acute leukemia and COVID-19 infection. Methods: Prospective cohort study of 26 patients with acute leukemia and COVID-19 infection confirmed by real-time PCR (nasopharyngeal and oropharyngeal swab). Indications for diagnosis of COVID-19: fever, lung symptoms (cough, dyspnea),screening. The severity of the infectious process was defined as: asymptomatic; mild - pneumonia without oxygen support; severe - severe pneumonia with SpO2 <92% and oxygen support; extremely severe - ARDS, the need for mechanical ventilation, sepsis, organ failure. In accordance with the clinical and hematological status for acute leukemia, all patients were divided into 2 groups: remission and no remission. Outcomes are defined as alive and dead. Results: The observation group consisted of 26 patients with a confirmed diagnosis of acute leukemia and COVID-19 infection in period from April 2020 to October 2021. Men - 18 (69.2%) and women 8 (30.8%), ratio 2.3:1. The median age was 62 years. The main oncohematological pathology is represented by ALL - 6 (23.1%); AML - 16 (61.5%), mixed type acute leukemia - 4 (15.4%). In 4 (15.3%) patients, COVID-19 infection was asymptomatic, 7 (26.9%) patients had mild, severe in 6 (2.31%) and extremely severe in 9 (34.7%) patients. In accordance with the clinical and hematological status for acute leukemia at the time of the infectious process, 11 (42.3%) patients were in remission, 15 (57.7%) patients had no remission. Polychemotherapy in terms from several days to several months was carried out in 22 (84.6%) patients, not in 4 (15.4%) patients.Of the 26 patients with acute leukemia and COVID-19 infection, 9 (34.6%) died, which accounted for almost 1/3. A greater number of patients with an unfavorable outcome were in AML - 9 (56.2%) patients out of 16, while in ALL all 6 (100%) patients were alive.There was a statistically significant decrease in overall survival in group no remission in patients with COVID-19 and acute leukemia (log-rank test, p=0.022). Image:Summary/Conclusion: 1) More than 50% of patients with acute leukemia have severe or extremely severe COVID-19.2) Patients with AML are more susceptible to adverse outcome of COVID-19 infection compared to patients with ALL.3) Overall survival in patients with acute leukemia and COVID-19 infection in remission is statistically significantly higher compared to patients in non-remission status (log-rank test, p=0.022).
PB2334: BURDEN OF HOSPITALIZATION, COSTS AND CO-MORBIDITIES IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA: ANALYSIS OF NATIONAL IN-PATIENT HOSPITAL DATABASE
Authors: S. Aggarwal, S. Kumar, A. Bela, O. Topaloglu
Journal: HemaSphere (2022)

Background: Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. It’s a type of cancer that starts in cells that become certain white blood cells in the bone marrow. Aims: To analyze trends in hospital length of stay, total costs and co-morbidities in Medicare and Private Insurance patients with Chronic Lymphocytic Leukemia (CLL). Methods: The National Inpatient Sample (NIS) data set from the Healthcare Cost and Utilization Project was utilized in order to determine the number of hospital admissions for Chronic Lymphocytic Leukemia. Thirty co-morbidities were assessed using Elixhauser scoring. The outcomes assessed include length of stay (LOS), total charges, co-morbidity score, mortality rate and emergency room visits. Results: There were an estimated 74,355 hospitalizations with a diagnosis of CLL, with 82% and 15% of the patients being covered by Medicare and Private Insurance, respectively. The mean age was 77.96 (SD 8.88) and 64.25 (SD 10.4) years for patients covered by Medicare and Private Insurance, respectively. The mean hospital length of stay was 5.81 (SD 6.01) and 5.91 (SD 7.18) days, for Medicare and Private Insurance patients, respectively. The mean hospital charges were $58,144 (SD $77558) and $66,721 (SD $91299) for Medicare and Private Insurance patients, respectively. The mean comorbidity score was higher for Medicare versus Private Insurance (Mean 4.22 vs 3.69, p<0.05). The in-hospital mortality rate was same 5.03% in both Medicare and Private Insurance patients. The top 5 co-morbid conditions in Medicare patients were Hypertension (45%), Cardiac Arrhythmias (39%), Fluid and Electrolyte Disorders (39%), Congestive Heart Failure (30%) and Chronic Pulmonary Disease (29%). Top 3 primary diagnoses were Sepsis, Pneumonia and Acute kidney failure. Approximately, 70% of Medicare patients were admitted to the hospital via the emergency room visit. Summary/Conclusion: Chronic Lymphocytic Leukemia patients pose significant burden on Medicare and Private Insurance with high hospital charges and long LOS. There is a need for new treatment options for CLL patients.
P1604: DISTRIBUTION AND ANTIBIOTIC RESISTANCE PROFILE OF PATHOGENIC MICROORGANISMS CAUSING NOSOCOMIAL INFECTION IN PATIENTS UNDERGOING HEMATOPOIETIC STEM CELL TRANSPLANTATION
Authors: J. Tao, F. Wu, L. Gao, A. Sun, Y. Feng, X. Zhang
Journal: HemaSphere (2022)

Background: In recent years, with the wide use of antibiotics and extensive invasive procedures, the drug resistance of bacteria causing nosocomial infection is becoming more and more serious. Due to the characteristics of hematopoietic stem cell transplantation patients and the use of large doses of chemotherapeutic drugs, a variety of immunosuppressants and a large number of broad-spectrum antibiotics, the immune function of patients is very low. As a result, the infection rate of hematopoietic stem cell transplantation patients in hospital is rising and new drug-resistant strains are emerging, which poses a great challenge to the control of nosocomial infection. Aims: To approach the distribution and antibiotic resistance profile of pathogenic microorganisms causing bloodstream infection in patients undergoing hematopoietic stem cell transplantation, so as to provide evidences for rational clinical use of antibiotics. Methods: The clinical data, including the types of pathogenic microorganisms and their resistance profile to commonly used antibiotics, of patients developing bloodstream infection during hematopoietic stem cell transplantation from January 2020 to December 2021 were analyzed retrospectively. Results: A total of 68 pathogenic strains were isolated from 405 patients undergoing hematopoietic stem cell transplantation, including 24 (35.3%) Gram-positive strains, primarily Staphylococcus and Enterococcus; 42 (61.8%) Gram-negative strains, primarily Escherichia coli and Klebsiella pneumoniae; and 2 (2.9%) fungus strains which were both Trichosporon asahii. Escherichia coli had the highest resistance rate (100%) to piperacillin, cotrimoxazole, and ampicillin, and the highest susceptibility rate (100%) to tigecycline, amikacin, imipenem, and meropenem. Klebsiella pneumoniae had the highest resistance rate (100%) to ampicillin, and the highest susceptibility rate (0) to tigecycline. The primary Gram-positive bacteria were 100% susceptible to teicoplanin, quinupristin/dafopentine, rifampicin, vancomycin, linezolid, nitrofurantoin, and amikacin; vancomycin-resistant enterococci (VRE) were not identified. Trichosporon asahii was 100% susceptible to amphotericin B, nystatin, caspofungin, and voriconazole. Summary/Conclusion: There are various pathogenic microorganisms that could cause bloodstream infection in patients undergoing hematopoietic stem cell transplantation, with high multi-drug resistance rate. The proportion of Gram-negative bacteria is increasing. During hematopoietic stem cell transplantation, it is expected to strengthen monitoring of the pathogenic microorganisms, so as to provide effective prevention to control infection with the pathogenic microorganisms, thus improving the patients’ survival rate.
Thrombopoietin receptor agonists in adult Evans syndrome: an international multicenter experience
Authors: Bruno Fattizzo, Nicola Cecchi, Marta Bortolotti, Giulio Giordano, Andrea Patriarca, Andreas Glenthøj, Silvia Cantoni, Marco Capecchi, Frederick Chen, Maria Eva Mingot-Castellano, Mariasanta Napolitano, Henrik Frederiksen, Tomàs José Gonzaléz-Lopez, Wilma Barcellini
Journal: Blood (2022)
Epigenomic analysis reveals a dynamic and context-specific macrophage enhancer landscape associated with innate immune activation and tolerance
Authors: Ping Zhang, Harindra E. Amarasinghe, Justin P. Whalley, Chwen Tay, Hai Fang, Gabriele Migliorini, Andrew C. Brown, Alice Allcock, Giuseppe Scozzafava, Phalguni Rath, Benjamin Davies, Julian C. Knight
Journal: Genome biology (2022)

Abstract Background Chromatin states and enhancers associate gene expression, cell identity and disease. Here, we systematically delineate the acute innate immune response to endotoxin in terms of human macrophage enhancer activity and contrast with endotoxin tolerance, profiling the coding and non-coding transcriptome, chromatin accessibility and epigenetic modifications. Results We describe the spectrum of enhancers under acute and tolerance conditions and the regulatory networks between these enhancers and biological processes including gene expression, splicing regulation, transcription factor binding and enhancer RNA signatures. We demonstrate that the vast majority of differentially regulated enhancers on acute stimulation are subject to tolerance and that expression quantitative trait loci, disease-risk variants and eRNAs are enriched in these regulatory regions and related to context-specific gene expression. We find enrichment for context-specific eQTL involving endotoxin response and specific infections and delineate specific differential regions informative for GWAS variants in inflammatory bowel disease and multiple sclerosis, together with a context-specific enhancer involving a bacterial infection eQTL for KLF4 . We show enrichment in differential enhancers for tolerance involving transcription factors NFκB-p65, STATs and IRFs and prioritize putative causal genes directly linking genetic variants and disease risk enhancers. We further delineate similarities and differences in epigenetic landscape between stem cell-derived macrophages and primary cells and characterize the context-specific enhancer activities for key innate immune response genes KLF4 , SLAMF1 and IL2RA . Conclusions Our study demonstrates the importance of context-specific macrophage enhancers in gene regulation and utility for interpreting disease associations, providing a roadmap to link genetic variants with molecular and cellular functions.
Myocarditis or Pericarditis Following mRNA COVID-19 Vaccination
Authors: Eric S. Weintraub, Matthew E. Oster, Nicola P. Klein
Journal: JAMA Network Open (2022)

Sarah A. Buchan, PhD; Chi Yon Seo, MSc; Caitlin Johnson, MPH; Sarah Alley, MPH; Jeffrey C. Kwong, MD; Sharifa Nasreen, PhD; Andrew Calzavara, MSc; Diane Lu, MD; Tara M. Harris, MHSc; Kelly Yu, MPH; Sarah E. Wilson, MD
PB2331: IN FRONT OF A DEEP VENOUS THROMBOSIS, LOOK AT THE HEMOGLOBIN!
Authors: S. Fendri, B. Mariem, B. S. Raida, J. Kamel, B. Zouheir
Journal: HemaSphere (2022)

Background: Venous thromboembolic disease is a public health problem whose diagnosis calls for adequate management, this management includes pathologies associated with thrombosis including anemia. In the course of our work, we propose to screen for cases of anemia in patients with deep vein thrombosis. Aims: In the course of our work, we propose to screen for cases of anemia in patients with deep vein thrombosis. Methods: This is an observational study involving patients under the age of 60 admitted to the internal medicine department for the management of deep vein thrombosis confirmed by imaging of unknown etiology. A complete blood count was taken for all patients included in the study performed by the sysmex XN1000 analyser. Results: Forty-seven patients were included in our study, mean age 40.8 ± 10.5 years with extremes of 18 and 59 years. The group consisted of 27 men (57.5%) and 20 women (42.5%). The sex ratio was 1.35. Fifteen patients had a body mass index exceeding 25 kg / m2. Venous thrombosis of IM was the most frequent localization observed in 34 patients (72.3%). Twelve patients (25.5%) were anemic. The anemia observed in both sexes was in 50% normochromic normocytic, and in 50% of cases microcytic. Hemoglobin level was significantly lower in folate deficiency (p = 0.05). Four patients (33%) had folate deficiency and hyperhomocysteinemia with normocytic anemia. All these patients received vitamin supplementation. Summary/Conclusion: Adequate management of deep vein thrombosis prompts a full etiological investigation and screening for anemia with possible vitamin deficiency requiring supplementation
PB2018: MULTIPLE MYELOMA WITH CENTRAL NERVOUS SYSTEM RELAPSE IN THE ERA OF NOVEL DRUGS - A MULTICENTER RETROSPECTIVE STUDY FROM THE CROATIAN COOPERATIVE GROUP FOR HEMATOLOGICAL MALIGNANCIES (KROHEM)
Authors: Z. Mitrovic, J. Batinic, D. Radic Kristo, I. Krecak, H. Holik, V. Perisa, T. Valkovic, H. Matijaca, M. Pirsic, S. Basic Kinda, I. Aurer
Journal: HemaSphere (2022)

Background: Central nervous system (CNS) relapse in multiple myeloma (MM) is a rare complication with dismal prognosis. It primarily affects transplant-eligible patients, and the incidence seems to be higher in the era of novel antimyeloma drugs. Aims: We aimed to assess clinical characteristics, treatment choices, and survival of these patients. Methods: This is a retrospective study by the Croatian Cooperative Group for Hematological malignancies (KROHEM). Patients with MM treated with novel agents prior to CNS relapse were included. Results: From April 2018 to October 2021, 13 patients from eight centers were identified. There were 8 men and 5 women, with a median age of 61 years (range 47-70 years). A median time from diagnosis to CNS progression was 3 years (ranging from 4 months to 7.5 years). Patients were treated with 1 to 5 lines (median 3) of systemic therapy prior to CNS progression. The patients progressed during treatment or maintenance with bortezomib-based regimen (3 pts), carfilzomib (2 pts), lenalidomide (3 pts), daratumumab (2 pts), pomalidomide (1 pt), bendamustine (1 pt), or in treatment-free remission (1 pt). Six patients had >10% plasma cells in bone marrow, whereas only a single patient had plasma cell leukemia. Nine patients had plasma cells in cerebrospinal fluid (CSF) and were treated with intrathecal therapy – median time to CSF clearance was two to three weeks. Nine patients had osteodural myeloma mass and 7 were irradiated. Systemic treatment was administered in 12 patients with CNS penetrating agents such as bendamustine + IMiDs, daratumumab +/- IMiDs, or other chemotherapy such as DT-PACE. At the time of analysis, three patients are alive with survival 3.5, 4.5, and 8 months from CNS relapse, respectively. Two of them were autografted with BEAM or melphalan/thiotepa conditioning. The median overall survival for all patients was 3 months (1-38 months). The longest survival had two patients treated with systemic therapy and local irradiation who died 11 and 38 months after CNS relapse, respectively (image). Image:Summary/Conclusion: CNS relapse in our cohort occurred as a late event; after a median of 3 years from diagnosis and a median of 3 prior therapy lines. Importantly, 7 of 13 CNS relapses occurred during treatment with CNS-penetrating agents. Consistent with previous reports, the median overall survival was only 3 months. The optimal treatment is unknown. Nevertheless, patients with localized osteodural infiltration amenable to radiotherapy and those autografted may have better survival. IMiDs in combination with bendamustine or daratumumab were the most frequently used systemic agents in our study.
PB2304: THROMBOTIC THROMBOCYTOPENIC PURPURA (TTP): A SINGLE-CENTER EXPERIENCE
Authors: F. Kammoun, Y. Fakhfakh, M. Charfi, O. Kassar, M. Chaari, L. Bouaoun, M. Bahloul, I. Frikha, F. Kallel, I. Ben Amor, L. Khalifa, M. Medhafar, S. Hadiji, H. Elleuch, H. Mnif, M. Bouaziz, M. Elloumi
Journal: HemaSphere (2022)

Background: Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, consumption thrombocytopenia, and organ injury. TTP pathophysiology is based on a severe ADAMTS13 deficiency, the specific von Willebrand factor (VWF)-cleaving protease. Aims: In this study, we aim to report our experience in patients with TTP, identify the main clinical and laboratory disease findings, treatment patterns, and evolution in these patients. Methods: This is a retrospective study of all adult patients (> 15 years) diagnosed and treated between 2000 and 2021 with TTP, at the hematology department of the university hospital of Sfax, Tunisia. Results: A total of 11 patients were enrolled in this study period. The median age was 38 years [range 22-72] and there was a female preponderance (2.6). At presentation, the majority of patients (8/11) had asthenia and neurological symptoms: confusion in 4 cases, convulsive seizure in 2 cases, and cerebrovascular accident in 2 cases. Five patients had fever, 4 had jaundice, and 3 presented with bleeding. Microangiopathic hemolytic anemia was noted in all patients with mean hemoglobin of 7.3 g/dl [5-8 g/dL], and 5% to 20% of schistocytes. Thrombocytopenia with platelets < 100x109/l occurred in 10 of 11 patients with mean platelet of 14 x109/l. Three patients had high serum creatinine levels, proteinuria and hematuria were present in 3 and 2 other cases respectively. The causal investigation showed that TTP was related to viral infection in 3 cases, newly discovered neoplasia in 2 cases, pregnancy in 3 cases, an immunologic disorder in one case, and idiopathic in 2 cases. Of the 3 pregnancy cases, 2 had a plasma activity of ADAMTS13 lower than 5%, and TTP was thus related to Upshaw-Schulman syndrome. For treatment, plasmapheresis associated with corticosteroids was promptly started in 9 patients, and 2 patients received corticosteroids alone due to hemodynamic instability. Four patients had also Rituximab as salvage therapy, and for the 2 patients with neoplasia, adequate chemotherapy was initiated. Four patients died due to shock with neurological involvement, respiratory failure, or multiple organic failure. The other 7 patients achieved remission, but two of them relapsed. Summary/Conclusion: Our study is consistent with clinical trial findings reported in the literature, showing that TTP has heterogeneous modes of presentation and not all patients have the complete typical features present. Since it has a fatal outcome, rapid diagnosis and management are recommended. Finally, the causal diagnosis should be made to initiate the appropriate curative treatment.